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Emergency Department Administration

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https://www.readbyqxmd.com/read/28096032/creation-of-an-intensive-care-unit-and-organizational-changes-in-an-adult-emergency-department-impact-on-acute-stroke-management
#1
Laurent Puy, Chantal Lamy, Sandrine Canaple, Audrey Arnoux, Nicolas Laine, Ella Iacob, Jean-Marc Constans, Olivier Godefroy
BACKGROUND AND PURPOSE: Following the reorganization of a University Medical Center onto a single campus, an Intensive Care Unit was created within the adult Emergency Department (ED ICU). We assessed the effects of these organizational changes on acute stroke management and the intravenous administration of recombinant tissue plasminogen activator (IV rtPA), as characterized by the thrombolysis rate, door-to-needle time (DNT) and outcome at 3months. METHODS: Between October 2013 and September 2015, we performed a retrospective, observational, single-center, comparative study of patients admitted for ischemic stroke and treated with IV rtPA during two 321-day periods (before and after the creation of the ED ICU)...
January 10, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28091839/impact-of-the-2014-2015-influenza-season-on-the-activity-of-an-academic-emergency-department
#2
Nicolas Beysard, Bertrand Yersin, Pascal Meylan, Olivier Hugli, Pierre-Nicolas Carron
The morbidity and mortality of the 2014-2015 influenza season were more important than those in previous years. We assessed the impact of the 2014-2015 influenza season on the length of stay (LOS) and workload in an academic emergency department (ED). This is a monocentric retrospective study. The database of the microbiology laboratory was used to identify influenza nasal swabs performed during the influenza seasons from 2010 to 2015. Patients admitted to the ED during these periods were identified through the administrative database and cross-checked with patients who underwent an influenza nasal swab in the ED...
January 16, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28087128/intranasal-oxytocin-to-prevent-posttraumatic-stress-disorder-symptoms-a-randomized-controlled-trial-in-emergency-department-patients
#3
Mirjam van Zuiden, Jessie L Frijling, Laura Nawijn, Saskia B J Koch, J Carel Goslings, Jan S Luitse, Tessa H Biesheuvel, Adriaan Honig, Dick J Veltman, Miranda Olff
BACKGROUND: There are currently few preventive interventions available for posttraumatic stress disorder (PTSD). Intranasal oxytocin administration early after trauma may prevent PTSD, because oxytocin administration was previously found to beneficially impact PTSD vulnerability factors, including neural fear responsiveness, peripheral stress reactivity, and socioemotional functioning. Therefore, we investigated the effects of intranasal oxytocin administration early after trauma on subsequent clinician-rated PTSD symptoms...
December 8, 2016: Biological Psychiatry
https://www.readbyqxmd.com/read/28079461/building-the-evidence-base-for-tele-emergency-care-efforts-to-identify-a-standardized-set-of-outcome-measures
#4
Yael Harris, Boyd Gilman, Marcia M Ward, Jonathan Ladinsky, Jacqueline Crowley, Cannon Warren, Craig Caplan
BACKGROUND: To enhance the quality of emergency department (ED) care, some rural hospitals have adopted the use of telemedicine (tele-ED). Without a common set of metrics, it is difficult to quantify the impact of this technology. INTRODUCTION: To address this limitation, the Health Resources and Services Administration funded the identification and testing of a core set of measures that could be used to build a business case for the value of tele-ED care. METHODS: A comprehensive environmental scan was conducted to identify existing measures relevant to assessing ED care and the use of telemedicine...
January 12, 2017: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/28075692/comparing-emergency-department-use-among-medicaid-and-commercial-patients-using-all-payer-all-claims-data
#5
Hyunjee Kim, K John McConnell, Benjamin C Sun
The high rate of emergency department (ED) use by Medicaid patients is not fully understood. The objective of this paper is (1) to provide context for ED service use by comparing Medicaid and commercial patients' differences across ED and non-ED health service use, and (2) to assess the extent to which Medicaid-commercial differences in ED use can be explained by observable factors in administrative data. Statistical decomposition methods were applied to ED, mental health, and inpatient care using 2011-2013 Medicaid and commercial insurance claims from the Oregon All Payer All Claims database...
January 11, 2017: Population Health Management
https://www.readbyqxmd.com/read/28074564/sustaining-sbirt-in-the-wild-simulating-revenues-and-costs-for-screening-brief-intervention-and-referral-to-treatment-programs
#6
Alexander J Cowell, William N Dowd, Michael J Mills, Jesse M Hinde, Jeremy W Bray
AIMS: To examine the conditions under which Screening, Brief Intervention and Referral to Treatment (SBIRT) programs can be sustained by health insurance payments. DESIGN: A mathematical model was used to estimate the number of patients needed for revenues to exceed costs. SETTING: Three medical settings in the United States were examined: in-patient, out-patient and emergency department. Components of SBIRT were delivered by combinations of health-care practitioners (generalists) and behavioral health specialists...
February 2017: Addiction
https://www.readbyqxmd.com/read/28072670/instruments-to-identify-commercially-sexually-exploited-children-feasibility-of-use-in-an-emergency-department-setting
#7
Stephanie Armstrong
OBJECTIVE: This review examines the screening instruments that are in existence today to identify commercially sexually exploited children. The instruments are compared and evaluated for their feasibility of use in an emergency department setting. METHODS: Four electronic databases were searched to identify screening instruments that assessed solely for commercial sexual exploitation. Search terms included "commercially sexually exploited children," "CSEC," "domestic minor sex trafficking," "DMST," "juvenile sex trafficking," and "JST...
January 9, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28072664/clinical-pathway-effectiveness-febrile-young-infant-clinical-pathway-in-a-pediatric-emergency-department
#8
Ashlee Lynn Murray, Elizabeth Alpern, Jane Lavelle, Cynthia Mollen
OBJECTIVE: Young infants are often treated in emergency departments (EDs) for febrile illnesses. Any delay in care or ineffective management could lead to increased patient morbidity and mortality. A standardized ED clinical pathway may improve care for these patients. The objective of this study is to evaluate the impact of a febrile young infant clinical pathway implemented in a large, urban children's hospital ED on the timeliness and consistency of care. METHODS: This study used a before-and-after retrospective observational study design comparing 2 separate periods: prepathway from September 2007 through August 2008 and postpathway from September 2009 through August 2010...
January 9, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28069483/epinephrine-use-in-older-patients-with-anaphylaxis-clinical-outcomes-and-cardiovascular-complications
#9
Takahisa Kawano, Frank Xavier Scheuermeyer, Robert Stenstrom, Brian H Rowe, Eric Grafstein, Brian Grunau
BACKGROUND: There is little data describing the differences in epinephrine (epi) administration and cardiac complications among older and younger patients with anaphylaxis. METHODS: This retrospective cohort study was conducted at two urban emergency departments (ED) over a 5 year-period, and included adults who met a pre-specified criteria for anaphylaxis. Patients≥50years of age were defined as "older". Univariate logistic regression was performed to compare the difference in frequency of epi administration between the "older" and "younger" groups...
January 6, 2017: Resuscitation
https://www.readbyqxmd.com/read/28068917/emergency-department-presentations-for-atrial-fibrillation-and-flutter-in-alberta-a-large-population-based-study
#10
Rhonda J Rosychuk, Michelle M Graham, Brian R Holroyd, Brian H Rowe
BACKGROUND: Atrial fibrillation or flutter (AFF) are not infrequent presenting problems in Emergency Departments (ED); however, little is known of the pattern of these presentations. This study provides a description of AFF presentations and outcomes after ED discharge in Alberta. METHODS: Provincial administrative databases were used to obtain all primary ED encounters for AFF during 1999 to 2011 for patients aged >35 years. Data extracted included demographics, ED visit timing, and subsequent visits to non-ED settings...
January 10, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/28065773/using-the-electronic-medical-record-to-identify-patients-at-high-risk-for-frequent-ed-visits-and-high-system-costs
#11
David W Frost, Shankar Vembu, Jiayi Wang, Karen Tu, Quaid Morris, Howard B Abrams
BACKGROUND: A small proportion of patients accounts for a very high proportion of healthcare utilization. Accurate pre-emptive identification may facilitate tailored intervention. We sought to determine whether Machine Learning techniques using text from a family practice Electronic Medical Record (EMR) can be used to predict future high Emergency Department (ED) use and total costs by patients who are not yet high ED users or high cost to the healthcare system. METHODS: Text from fields of the Cumulative Patient Profile within an EMR (PS Suite) of 43,111 patients was indexed...
January 5, 2017: American Journal of Medicine
https://www.readbyqxmd.com/read/28062114/effect-of-immediate-administration-of-antibiotics-in-patients-with-sepsis-in-tertiary-care-a-systematic-review-and-meta-analysis
#12
REVIEW
Amy N B Johnston, Joon Park, Suhail A Doi, Vicki Sharman, Justin Clark, Jemma Robinson, Julia Crilly
PURPOSE: The goal of this review was to synthesize existing evidence regarding outcomes (mortality) for patients who present to the emergency department, are administered antibiotics immediately (within 1 hour) or later (>1 hour), and are diagnosed with sepsis. METHODS: A search of PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL, using the MeSH descriptors "sepsis," "systemic inflammatory response syndrome," "mortality," "emergency," and "antibiotics," was performed to identify studies reporting time to antibiotic administration and mortality outcome in patients with sepsis...
January 3, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28053261/the-epidemiology-and-trends-in-management-of-acute-achilles-tendon-ruptures-in-ontario-canada-a-population-based-study-of-27-607-patients
#13
U Sheth, D Wasserstein, R Jenkinson, R Moineddin, H Kreder, S B Jaglal
AIMS: The aims of this study were to establish the incidence of acute Achilles tendon rupture (AATR) in a North American population, to select demographic subgroups and to examine trends in the management of this injury in the province of Ontario, Canada. PATIENTS AND METHODS: Patients ≥ 18 years of age who presented with an AATR to an emergency department in Ontario, Canada between 1 January 2003 and 31 December 2013 were identified using administrative databases...
January 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/28046080/the-annual-burden-of-seasonal-influenza-in-the-us-veterans-affairs-population
#14
Yinong Young-Xu, Robertus van Aalst, Ellyn Russo, Jason K H Lee, Ayman Chit
Seasonal influenza epidemics have a substantial public health and economic burden in the United States (US). On average, over 200,000 people are hospitalized and an estimated 23,000 people die from respiratory and circulatory complications associated with seasonal influenza virus infections each year. Annual direct medical costs and indirect productivity costs across the US have been found to average respectively at $10.4 billion and $16.3 billion. The objective of this study was to estimate the economic impact of severe influenza-induced illness on the US Veterans Affairs population...
2017: PloS One
https://www.readbyqxmd.com/read/28045940/applying-the-integrated-practice-unit-concept-to-a-modified-virtual-ward-model-of-care-for-patients-at-highest-risk-of-readmission-a-randomized-controlled-trial
#15
Lian Leng Low, Shu Yun Tan, Matthew Joo Ming Ng, Wei Yi Tay, Lee Beng Ng, Kanchana Balasubramaniam, Rachel Marie Towle, Kheng Hock Lee
BACKGROUND: Emerging evidence from the virtual ward care model showed that multidisciplinary case management are inadequate to reduce readmissions or death for high risk patients. There is consensus that interventions should encompass both pre-hospital discharge and post-discharge transitional care to be effective. Integrated practice units (IPU) had been proposed as an approach of restructuring the organization and work processes of multidisciplinary teams to achieve value in healthcare...
2017: PloS One
https://www.readbyqxmd.com/read/28041578/severe-mental-illness-and-emergency-department-service-use-nationally-in-the-veterans-health-administration
#16
Stephanie V Ng, Robert A Rosenheck
No abstract text is available yet for this article.
January 2017: General Hospital Psychiatry
https://www.readbyqxmd.com/read/28032826/variation-in-emergency-department-transfer-rates-from-nursing-homes-in-ontario-canada
#17
Andrea Gruneir, Susan E Bronskill, Alice Newman, Chaim M Bell, Peter Gozdyra, Geoffrey M Anderson, Paula A Rochon
BACKGROUND: Nursing home (NH) residents are frequently transferred to the emergency department (ED) but there is little data on inter-facility variation, which has implications for intervention planning and implementation. OBJECTIVES: To describe variation in ED transfer rates (TRs) across NHs and the association with NH characteristics. DESIGN/SETTING: Retrospective cohort study using linked administrative data from Ontario. PARTICIPANTS: 71,780 residents of 604 NHs in 2010 and followed for one year...
November 2016: Healthcare Policy, Politiques de Santé
https://www.readbyqxmd.com/read/28028867/the-clinical-status-and-economic-savings-associated-with-remission-among-patients-with-rheumatoid-arthritis-leveraging-linked-registry-and-claims-data-for-synergistic-insights
#18
Jeffrey R Curtis, Lang Chen, Jeffrey D Greenberg, Leslie Harrold, Meredith L Kilgore, Joel M Kremer, Daniel H Solomon, Huifeng Yun
INTRODUCTION: Treat to target guidelines recommend achieving remission or low disease activity in rheumatoid arthritis (RA). However, the reduction in adverse events and costs associated with lower disease activity is unclear. METHODS: We used Corrona linked to Medicare data to identify RA patients. Time varying disease activity was measured using Clinical Disease Activity Index (CDAI); outcomes included all-cause hospitalization, a composite of hospitalization or emergency department (ED) visits, mortality, and medical costs...
December 28, 2016: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/28007364/factor-eight-inhibitor-bypassing-agent-feiba-for-reversal-of-target-specific-oral-anticoagulants-in-life-threatening-intracranial-bleeding
#19
Gordon Mao, Lauren King, Sarah Young, Richard Kaplan
INTRODUCTION: As increasing number of patients present to emergency departments with life threatening hemorrhages, particularly intracranial hemorrhage on anticoagulation physicians must be cognizant of the limitations of the available reversal options. Based upon the available literature, our institution formulated a reversal algorithm for patients with life-threatening bleeding on factor Xa inhibitors by administering factor eight inhibitor bypassing agent (FEIBA) 20 units/kg. METHODS: A retrospective chart review was performed to include all patients who received FEIBA per institutional protocol...
December 19, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28004512/a-rapid-access-clinic-to-improve-delivery-of-ambulatory-care-to-cancer-patients
#20
James C Kuo, Madhawa De Silva, Chandra Diwakarla, Desmond Yip
BACKGROUND: Cancer patients may find it challenging to access timely advice and care. We evaluated the improvement in delivering ambulatory care in establishing a Rapid Assessment Clinic (RAC) in a cancer center. METHODS: Patients receiving chemotherapy who presented for assessment at the RAC from September 2013 to June 2014 were included for review. Patient demographics, tumor characteristics, presenting complaints, time to assessment, total time spent at the RAC and assessment outcome were extracted...
December 22, 2016: Asia-Pacific Journal of Clinical Oncology
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